Kutheni nokuba ukuhlaselwa kwentliziyo "enobulali" kunokuba yinto enkulu
I-non-ST yesigaba sokuphakama kwe-myocardial infarction (NSTEMI) kunye ne-ST-section elevation myocardial infarction (STEMI) ziyaziwa ngokuba yi-heart attack. I-NSTEMI yinto encinane kunazo zonke, kubalwa malunga neepesenti ezingama-30 zazo zonke iintliziyo.
I-NSTEMI, STEMI, kunye nemeko yesithathu ebizwa ngokuba yi-angina engaqinisekanga yintlobo yesifo se-coronary syndrome (ACS) .
Ngenxa yecandelo layo, i-ACS ichazwa nje nayiphi na imeko eyenziwe ngokunciphisa ngokukhawuleza okanye ukucima ukuhamba kwegazi entliziyweni.
Ukuqonda i-Acon Coronary Syndrome
Zonke iifom ze-ACS zivame ukubangelwa ukuphuka kweplates kwi- artery coronary , ekhokelela ekukhethweni okanye ekuphelelweni komkhumbi. Ngokuxhomekeke kubukhulu bokuthintela, i-ACS inokufakwa kwiintlobo ezahlukeneyo ezintathu:
- I-angina engaqinisekanga yintlupheko yecala elibangela iintlungu zesifuba. Ngokungafani no-angina ozinzile (okwenzekayo xa uzikhandla), i-angina engaqinisekanga iyakwenzeka naliphi na ixesha kwaye ithathwa njengongqongqo. Nangona kunjalo, i-angina engaqinisekiyo ayibangeli umonakalo ongenakunzima entliziyweni.
- I-STEMI ithathwa njenge- "classic" ekuhlaselweni kwentliziyo apho iplantshi ephuliweyo ngokupheleleyo okanye kufuphi nayo ibhalela ngokupheleleyo umthambo omkhulu wegononary, okubangelwa kukulimala kwenhliziyo.
- I-NSTEMI ithathwa njenge-"intermediate" ifom ye-ACS ekukhuselweni kuyo kwenzeka kwi-artery coronary encinci okanye ibangela ukuphazamiseka okuyingcipheko yombono omkhulu wecononary. Nangona iimpawu zifana ne-STEMI, umonakalo entliziyweni uya kuba lukhulu kakhulu.
I-NSTEMI kunye ne-angina engaqinisekanga kuya kufuthi iqhubele phambili "ukuzaliswa" kwenhliziyo kwithuba leeyure ezimbalwa okanye iinyanga. Ngaloo ndlela, nganye inokuthi ithathelwe ingqalelo kubaphambili kwi-STEMI kunye nesilumkiso sokuqala sokuthi uncedo olunganyango lwezonyango olufunekayo.
Ukuhlukana kweNSTEMI kwi-STEMI
Ukuxilongwa kwe-NSTEMI kwenziwa ngokuqhelekileyo xa umntu eneempawu ze-angina engaqinisekanga.
Siyakwazi ukuhlula i-STEMI kwi-NSTEMI ngokufunda kwi- electrocardiogram (ECG) kwi-"ST-segment". Ngokweemeko eziqhelekileyo, isigaba se-ST sisicatshulwa esicacileyo sibona kwi-ECG phakathi kweentliziyo. Ngexesha lokuhlaselwa kwentliziyo, isigaba se-ST siphakanyiswa. Ngaloo ndlela, i-NSTEMI ifumana igama layo kuba akukho bungqina bendawo ye-ST phezulu.
Ngenxa yokuba i-NSTEMI ibangela umonakalo kwimisipha yeentliziyo, oogqirha baya kucinga ukuba i-heart attack (abanye bangathi "ukuhlaselwa kwentliziyo"). Xa kuthethwa ukuba, i-NSTEMI inokufanayo kunye ne-angina engaqinisekanga kwaye, ngoko kunjalo, ngokuqhelekileyo, ineziphumo ezingcono.
Unyango oluphuculweyo lweNSTEMI
Ukunyangwa kwe-NSTEMI kufana neyo-angina engaqinisekanga. Ukuba umntu ubonakala eneempawu zomzimba (ukuqina kwesifuba, ukutywina kwesikhumba, iintlungu zokudubula kwisandla sokunxele, njl.), Ugqirha uya kuqala unyango olunzulu ukuzinzisa intliziyo nokukhusela umonakalo omkhulu.
Ukuzinzisa kuza kugxila kwizinto ezimbini:
- Ukuphelisa i-ischemia enzima , imeko apho intliziyo ayifumani oksijini okwaneleyo, ebangela ukufa kwesisele. Oku kwenziwa, ngokwengxenye, ngokulawula i- beta blockers ukukhusela umonakalo obangelwa yimveliso engaphezulu kwe-adrenaline kunye ne-high-dose statins ukuzinzisa i-plaque ephuliweyo nokunciphisa ukuvutha komzimba. Ukusetyenziswa kwezi zonyango kuya kunciphisa i-carchemac ischemia ngemizuzu. I-oksijeni kunye ne-morphine ziya kunikwa ngokubanzi ukunceda ukuphefumula nokunciphisa intlungu.
- Ukumisa i-clot form formation kuquka ukusetyenziswa kwe-aspirin, i-Plavix, kunye neminye imithi yokucutha igazi kunye nokukhusela ukudibanisa kweeplatelet. Kwakhona kubandakanya ukuphepha kwe "busters clot", esetyenziswa rhoqo kwi-STEMI, nto leyo eyenza izinto zibe zibi nakakhulu.
Yintoni eyenzekayo emva kokuba uMbuso uzinzile
Xa isiguli sigxininiswe, ugqirha uya kuhlola ukuba ngaba kungenelelo olongezelelweyo olufunekayo. Uninzi lwezifo ze-cardiologists ziza kusebenzisa i-TIMI (thrombosis kwi-myocardial infarction) amanqaku ukucacisa umphumo womntu ngamnye.
Isikolo seTIMI sivavanya ukuba ngaba umntu unalo na ma
- Uneminyaka eyi-65 okanye ngaphezulu
- Ubuncinane ubuncinane bezinto ezinobungozi zesifo senhliziyo
- Ukukhutshwa kwe-coronary engaphezulu kwama-50 ekhulwini
- I-ST-segment deviation kwi-ECG yokungena
- Ubuncinane amabini episodes kwiiyure ezingama-24 ezedlulileyo
- Ukuphakanyiswa kwama-enzyme enhliziyo
- Ukusetyenziswa kwe-aspirin kwiintsuku ezisixhenxe ezedlulileyo
Ukuba umntu unobini okanye ubuncinane kule micimbi yobungozi (i-TIMI score 0-2), imfuneko yokungenelela kwangakumbi iyakuthi igwenywe. Ukuba amanqaku aphezulu, i-cardiologist ingathanda ukwenza i- catheterization yenyama kunye ne- angioplasty kunye ne- stenting .
Kubantu abanqabileyo unyango olungenangxaki, uvavanyo loxinzelelo luya kwenziwa ngaphambi kokuba lukhutshwe. Ukuba kukho nayiphi na imiqondiso ye-carchemac ischemia, unyango olungenayo luya kucetyiswa ngamandla.
> Umthombo
- > Amsterdam, E .; Wenger, N; Brindis, R .; okqhubekayo. "Isikhokelo se-AHA / ACC sokulawulwa kwezigulane ezingenayo i-ST-elevation syndary syndromes eziphambili: isishwankathelo esiphezulu: ingxelo ye-American College of Cardiology / American Heart Association Task Force on Practice Guidelines." Ukuhamba. 2014; 130: 2354.